Biomedical subjects
Publications and source records attributed to J D Wilkinson.
Patch testing of 40 patients with chronic inflammatory ear disease demonstrated medicament allergic contact dermatitis in 35%. The most frequent sensitizers were neomycin, framycetin, clioquinol and gentamicin. Although allergic contact dermatitis to dewaxing ear drops was unusual, irritant reactions were common.
Two cases of long-standing alopecia totalis treated with topical minoxidil are described. The mechanism of minoxidil hypertrichosis is discussed.
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Of 31 severely mentally and physically handicapped children with gastroesophageal reflux treated with a standard medical regimen, only eight (26%) had complete or partial therapeutic response. Fourteen of 23 medical failures underwent Nissen fundoplication with a good therapeutic response in 12. There were 12 intra- and postoperative complications in six surgical patients. Two late postoperative deaths from pulmonary aspiration occurred in the surgical group (14%), both of whom had abnormal deglutition preoperatively. In nine patients who failed on medical management but in whom surgery was not performed there was continuing morbidity from emesis (88%), anemia (44%), and pulmonary disease (33%), and two deaths (22%) resulting from pulmonary aspiration. We conclude that conventional medical therapy of GER is less effective in retarded than in normal infants and children, and that surgical treatment is associated with high operative risk but has an ultimately acceptable outcome. Continued medical therapy after initial failure to control symptoms is associated with significant morbidity and mortality.
Eighteen patients with Darier's disease were treated for at least 3 months with the oral aromatic retinoid Tigason (etretinate, Ro 10-9359). Seventeen of the 18 patients improved but adverse effects were seen in all patients, and were particularly severe in 6. No haematological or biochemical abnormalities were detected during treatment. We conclude that Tigason is an important advance in the treatment of Darier's disease but adverse effects restrict its use in some patients.
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Nineteen patients with carcinoma cuniculatum are presented. Of these, 17 were male and two were female. The age range was from 26 to 73 years with a mean of approximately 54 years. Sixteen tumours were located on the foot, the other three were situated on the knee, wrist and finger respectively. The pathological features of carcinoma cuniculatum are described and the aetiology of the tumour is discussed.
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A prospective study of allergic contact dermatitis after metal-on-plastic total hip replacement was undertaken in 69 patients, of whom 54 were available for review after operation. Before operation six patients were metal sensitive, but only one remained so afterwards; this patient had given a clear history of metal sensitivity and a titanium prosthesis had therefore been used. In all six patients the result of the operation was good and no case of loosening occurred. Sixty-three patients had negative patch tests before operation; in none of these was metal sensitivity detected after operation. Cutaneous sensitivity to various metals is well documented after the insertion of metal-on-metal prostheses and in failed prostheses. We have not found any such increased sensitivity after metal-on-plastic hip replacement. There is little evidence of a direct causal relationship between metal sensitivity and subsequent loosening. The cutaneous sensitivity may be the consequence of loosening rather than its cause. Our results suggest that, providing metal-on-plastic prostheses are used, routine patch testing before hip replacement is no longer required.
A 3-year study of patch test reactions to the Standard European Battery (S. E. B.) has been carried out in two adjacent areas of South-east England with the same climatic and cultural background. The source of materials and method of testing were identical; all observers have worked together in the same Contact Dermatitis Clinic and the interpretation of reactions can therefore be considered to be consistent. The main differences between the two areas lay in the pattern of employment and in local prescribing habits. Only the second aspect is considered here. Seven allergens--lanolin, neomycin, parabens, iodochlorhydroxyquinoline, ethylene diamine, caine 'mix' and chlorocresol--accounted for approximately 30% of all positive patch test reactions. 'Medicament sensitivity' correlated well with the known prescribing habits of both regions. Certain sites were shown to be especially important in the pathogenesis of medicament contact sensitivity.
A case of twenty-nail dystrophy of childhood is reported. The histopathological findings were distinctive and incompatible with the notion that this condition might be a variant of lichen planus.
A continuing study of perioral dermatitis over a period of 12 years is presented. A distinction is made between various patterns of circumoral and paranasal dermatitis and the clinical picture that we describe as "perioral dermatitis". No cases were seen before 1966 but the number of patients presenting to hospital clinics or in private practice rose dramatically until 1970-1972, after which there has been a progressive fall in numbers. In this period, 259 patients were diagnosed as having the condition and of these 203, resident in an area of some 275,000 population and seen by one or other of us on at least two occasions, form the basis of this study. There were 173 females, fifteen males and fifteen children under 12 years of age. In many cases it was possible to suggest the primary lesion for which patients sought treatment. In sixty-nine patients this consisted of a para-oral eruption on the side of the chin and, in forty-one a paranasal erythematous dermatitis. The characteristic appearance and spread of the eruption to the glabella and eyelids are described. A few patients, mostly male, showed lesions around the eyelids only, from treatment of seborrhoeic dermatitis. All but nine of the patients acknowledged the use of potent (not necessarily fluorinated) topical corticosteroids over long periods; in many cases these were self-administered. Some of the children had been treated with preparations intended for their mothers. The numerous aetiological agents that have been incriminated as causes of this eruption are examined. We believe that the prolonged use of topical potent corticosteroids is the only one tenable from our observations. The role of hormonal factors and of local irritant agetns is examined in this context. Tetracyclines are curative in the great majority of patients in 6 weeks if local corticosteroids are discarded. Relapses are rare. Perioral dermatitis is a most satisfying condition to treat but several questions remain unanswered. The current "revolt" against all forms of cortisone may enable us to answer some of these in the near future.
Fourteen cases of Hutchinson's lentigo maligna and eight further cases with nodular invasive areas in whom liquid nitrogen spray has been curative are reported. We suggest that in view of its simplicity and efficacy, cryotherapy is the treatment of choice for the macular phase and possibly also for the nodular invasive stage.